Follow-Up of Spina Bifida Children with and without Upper Renal Tract Changes at Birth

Abstract

The aim of this study was to assess 2 groups of children with spina bifida; one with and the other without upper renal tract (URT) changes at birth and to evaluate the outcome of their management. In Group 1, there were 148 patients who had normal URT at birth. They were studied for a mean follow-up of 131 months. Twenty-eight per cent developed URT changes in later life. The median time interval for URT changes to develop between birth and the first assessment which showed abnormal finding, was 33 months and between the last normal URT assessment and the development of URT changes, was 16 months. Six patients with URT changes were treated conservatively and 36 required intervention. Twenty-eight of 42 patients showed initial improvement of URT changes but 25 subsequently deteriorated. In 3 patients renal function deteriorated with renal failure in one and renal impairment in 2. In Group 2, 24 patients who had URT changes present at birth were also studied for a mean follow-up of 115 months. The URT changes in 8 patients deteriorated after the initial assessment over a median time of 15 months. Twelve patients' URT changes improved spontaneously without active intervention over a median time interval of 16 months but 5 subsequently deteriorated. Overall, the prognosis of children with URT changes at birth did not seem to be any worse than children developing changes later in life. Lesions of sacral and thoraco-lumbar regions of the spine were most commonly associated with URT changes.(ABSTRACT TRUNCATED AT 250 WORDS)

Spinal dysraphism and neurogenic bladder: Still a relevant topic

“…Early start of CIC is the most important factor to avoid renal damage. It was reported that the prognosis of children with upper renal tract changes at birth did not seem to be any worse than children developing changes later in life [11] . Five of the 6 patients with renal scarring in Dik and al report, were started on therapy with intermittent catheterization and antimuscarinic therapy several months after birth [3] .…”

Congenital urinary obstruction and renal failure: has fetal ultrasound improved the prognosis?

“…However, up to 86% of children have normal kidneys at birth. 22 In the absence of effective bladder management, there is an increasing incidence of renal damage from 21% at 2 weeks and 28% by 3 months. 23 By the end of childhood, 30-60% have renal scars.…”

“…The problem is the neuropathic bladder, characterised by detrusor‐sphincter dyssynergia, which effectively causes functional bladder outflow obstruction (Figure 4). However, up to 86% of children have normal kidneys at birth 22 . In the absence of effective bladder management, there is an increasing incidence of renal damage from 21% at 2 weeks and 28% by 3 months 23 .…”

Urodynamic Findings and Renal Function in Children with Neurogenic Bladder after Myelomeningocele

“…Inappropriate innervations of the urinary bladder can cause abnormal function during the storage and voiding phase, and in this way can also lead to renal damage/failure, with renal replacement therapy included [9,10]. Renal failure is still the most severe complication and remains the main cause of death both in adults and children with MMC since the late 1950s when shunting devices to treat the hydrocephalus were established [11,12]. The study by Muralikrishna et al [13] revealed that the median age for renal transplantation in MMC patients was 27 years.…”